Basic Information
Provider Information | |||||||||
NPI: | 1225600232 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MOWATT | ||||||||
FirstName: | RACHEL | ||||||||
MiddleName: | ANNE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11814 S BRIAR PATCH DR | ||||||||
Address2: |   | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 231132394 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9089146915 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 107 E 3RD AVE | ||||||||
Address2: |   | ||||||||
City: | FRANKLIN | ||||||||
State: | VA | ||||||||
PostalCode: | 238511719 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7577763088 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2021 | ||||||||
LastUpdateDate: | 07/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0008X | 2305213891 | VA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
No ID Information.